NOTE: This policy applies to Undergraduate Students only and petitions will NOT be considered for courses taken over 5 years ago.
In order for undergraduates to petition for a change in a grade received at IUPUI within the last 5 years, you must complete this form.
We ask that you type your information on the form and then print it. Grade change requests are subject to all restrictions established by the faculty. While the Office of the Registrar collects the Grade Change Petition form and supporting documents, we forward to the appropriate school for review and follow-up.

1. Name

2. Ten Digit University ID Number

3. Name (if different while at IUPUI)

4. Date

5. Current Address Street

City State Zip

6. Daytime Phone - - Evening Phone - -

7. E-mail

8. List the courses in which you are petitioning for a grade change

Department

Course Number

Course Title

Semester/Year Taken

9. Are you presently enrolled at an Indiana University Campus?

If yes,which campus? What is your major?

If no, skip to item 12.

10. If you are presently an IU Student, have you already used the grade replacement (FX) option?

Yes
No

Check here if your school does not honor FXs

Check here if you have changed your major, don't need these courses, or would rather not retake them

11. Is this your first semester back after a break of one or more semesters?

Yes
No

Many schools at IUPUI will not take action on a request to change grades until you have established a track record of progress (12 to 20 credits of a C or better). Skip to Item 15.

12. Are you currently enrolled in a college or university other than in the IU system?

Yes
No

If yes, please name the college you are attending:

What degree are you working on at this college?

What is your major?

Please attach a current transcript if you are enrolled at a non-IU school. If you are trying to be admitted to a college or university and are not admissible because of your prior record, please include a letter from the college regarding this matter.

Please answer the following items.

13. If you are not
presently attending a college, what are your future educational plans?

14. If you are not planning to return to college, but your grades are affecting other aspects of your life, please explain in detail.

15. (A) Please explain why you received the grades you wish changed. Be sure to indicate whether you completed all of the course requirements including the final examination. The documentation is critical.

15. (B) Indicate whether you want the grade of F or D changed to a W (withdrawal) or if you want a grade changed to a specific letter grade (such as A, B, C, or D). If you want a grade changed to a specific letter grade, you must provide an explanation for the change and include a syllabus, class work and test results. If the instructor is still at IUPUI, you should discuss the matter with the instructor prior to filing this petition. If you are concerned about privacy regarding the causes of poor grades, be assured that the university regards this petition as confidential. Only persons with a need to know will see any confidential materials, such as medical records, which you may submit. If you are still concerned, you may indicate a phone number and a time at which you may be reached to discuss this issue. If you don't recall the name of your instructor, you may call the school in which the course was offered.

16. If you have transferred to another institution, please explain why the change of grade is critical. Since most schools don't count grades from other colleges in your grade point average, and don't transfer in courses with grades of D or F, be sure to explain the specific impact on your academic future of the grades that you wish changed.

17. What evidence can you provide that you have adopted a new attitude or approach to education and/or have become a more serious student?

Note: If you wish to add additional information, it
must be in typed format and attached to this document.

______________________________________________________

Student Signature

If you have questions concerning this petition, please contact the IUPUI School which taught the course(s) specified.